Omicron anecdata?

[mommyoffive]

New Covid boosters expected soon for everyone over age 12 (nbcnews.com)

[Corraleno]

I've just been assuming that people over 65 would be able to get the new BA4/5 booster this fall even if they've already had 2 of the original boosters, but in reading various articles and twitter threads recently, I'm not actually seeing anything about that — just references to people getting the new version for their 1st or 2nd booster. Has anyone seen or heard anything that would suggest that fully-boosted seniors would still be eligible for an updated shot this fall?

[KSera]

1 hour ago, Corraleno said:

I've just been assuming that people over 65 would be able to get the new BA4/5 booster this fall even if they've already had 2 of the original boosters, but in reading various articles and twitter threads recently, I'm not actually seeing anything about that — just references to people getting the new version for their 1st or 2nd booster. Has anyone seen or heard anything that would suggest that fully-boosted seniors would still be eligible for an updated shot this fall?

At some point, I think I saw something suggesting it would need to be at least four months from a second booster, but I haven’t seen that recently. I honestly think they’re not sure yet what they’re going to say. 

[Arcadia]

1 hour ago, Corraleno said:

I've just been assuming that people over 65 would be able to get the new BA4/5 booster this fall even if they've already had 2 of the original boosters, but in reading various articles and twitter threads recently, I'm not actually seeing anything about that — just references to people getting the new version for their 1st or 2nd booster. Has anyone seen or heard anything that would suggest that fully-boosted seniors would still be eligible for an updated shot this fall?

 

15 minutes ago, KSera said:

At some point, I think I saw something suggesting it would need to be at least four months from a second booster, but I haven’t seen that recently. I honestly think they’re not sure yet what they’re going to say. 

Since the funding is going to transition from government to insurance, probably everything is still up in the air as to how many of the new boosters would be purchased with government funds.

https://amp.cnn.com/cnn/2022/08/16/health/biden-administration-covid-19-vaccines-tests-treatments/index.html
“The Biden administration has been planning for how to get past the crisis phase of the Covid-19 pandemic and will stop buying vaccines, treatments and tests as early as this fall, White House Covid-19 Response Coordinator Dr. Ashish Jha said on Tuesday.

… "My hope is that in 2023, you're going to see the commercialization of almost all of these products. Some of that is actually going to begin this fall, in the days and weeks ahead. You're going to see commercialization of some of these things," he said.

… Officials plan to use that money to buy updated vaccine booster shots that protect against the BA.4 and BA.5 coronavirus subvariants, which Jha said would be ready in early to mid-September. 

"I would like to get to a point where every adult in America who wants a vaccine can get one. I'm hopeful we will be there. We're not quite there yet in terms of how many vaccine doses we've been able to buy," he said.

… The US has seen little to no flu transmission for the past two years largely because of Covid-19 mitigation measures like masking. 

"I expect the fall and winter to look much more like the fall and winter of 2019, with a lot less mitigation," Jha said.”

[Katy]

If I want to go get PCR tests (mostly for medical records reasons), are there certain places where you’re likely to find what variant you have? Or is that specific to certain hospitals or locations?

[Arcadia]

3 hours ago, Katy said:

If I want to go get PCR tests (mostly for medical records reasons), are there certain places where you’re likely to find what variant you have? Or is that specific to certain hospitals or locations?

https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas-other-tests-sars-cov-2#genotyping

“Individual EUAs for Genotyping Tests for SARS-CoV-2

This table includes information about authorized SARS-CoV-2 genotyping tests that have been authorized for the identification and differentiation of SARS-CoV-2 Phylogenetic Assignment of Named Global Outbreak (PANGO) lineages and/or for the identification of specific SARS-CoV-2 mutations. 
 

 

Date EUA Issued or Last Updated	Entity	Diagnostic (Most Recent Letter of Authorization) and Date EUA Originally Issued
07/28/2022	Twist Bioscience Corporation	SARS-CoV-2 NGS Assay 03/23/2021
06/10/2022	Laboratory Corporation of America (Labcorp)	Labcorp VirSeq SARS-CoV-2 NGS Test 06/10/2022

[mommyoffive]

Omicron-specific Covid booster shots are just weeks away. Here's who will—and won't—be eligible (msn.com)

 

Omicron-specific booster shots are weeks away: Eligibility guide (cnbc.com)

Newly updated Covid booster shots designed to target omicron's BA.5 subvariant should be available within in the next three weeks. That begs an important question: Who's going to be eligible to get them?

The short answer: Anyone ages 12 and up who has completed a primary vaccination series, a Centers for Disease Control and Prevention spokesperson tells CNBC Make It. It's unlikely to matter whether you've received any other booster doses or not before, the spokesperson says — but if you're unvaccinated, you won't eligible for the updated formula until you complete a primary series with the existing Covid vaccines.

Pfizer's "bivalent" shot, which targets both the original Covid strain and omicron's BA.5 subvariant, is expected to authorized first. The CDC says it'll likely come with a wide eligibility swath: The full group of vaccinated Americans ages 12 and up.

Moderna's bivalent shot is expected to follow suit later, most likely in October. It'll come with a somewhat narrower range of eligibility, at least at first: vaccinated people ages 18 and older. For both shots, younger pediatric age groups could become eligible later, the CDC says.

Those projections are tentative, at least for now. A person familiar with the matter told NBC News on Wednesday that it'll hinge on how much supply Pfizer and Moderna are able to manufacture and roll out by next month. If that supply is limited, the shots could first be available to those most at risk, such as the elderly and immunocompromised.

Federal health officials believe the shots will provide the best level of protection against the highly transmissible BA.5 subvariant to date, especially in the fall and winter when a large wave of Covid infections is projected to hit the U.S.

"It's going to be really important that people this fall and winter get the new shot. It's designed for the virus that's out there," Dr. Ashish Jha, the White House's Covid response coordinator, said at a virtual event hosted by the U.S. Chamber of Commerce Foundation on Tuesday.

Should I get a fourth booster dose now, or wait for the omicron-specific shots?

If you haven't received your second booster dose yet, Jha's advice is to get it now rather than holding off in anticipation of the updated boosters. 

Edited August 21, 2022 by mommyoffive

[Laura Corin]

Husband has been sent his appointment for a bivalent booster. It's not until November. He's 65 but healthy - I know that my mother will get hers sooner, as I've already been told it should be soon. I'll be further down the list - healthy and younger.

[ktgrok]

I JuST got the two middle kids boostered last week. Am hoping maybe 12 yr old could get the new bivalent before Christmas maybe?

And if that timeline holds, hopefully DH can be boostered before he goes on his next work trip mid october - I wasn't super worried about this last trip since it was only 2 months after having covid, but that one will put him out of that window. I'd feel better if he and I were boostered with the new one. 

I normally get my flu shot in October as well, may try to space that out...

[mommyoffive]

State of Affairs: COVID-19, MPX, and ...Polio (substack.com)

COVID-19

 

In most countries, BA.5 is beginning to wind down. This is a welcome reprieve given that in the past four weeks we lost 62,892 people worldwide, including 15,100 Americans. Japan, however, is still getting hit hard and is experiencing the highest number of deaths since the beginning of the pandemic. Notably, Australia has had sustained, high rates of death during their winter season. Cumulatively, deaths in both countries remain far below the U.S., though.

In the U.S., all metrics (reported cases, test positivity rate, hospitalizations, and wastewater) remain high but have clearly peaked and well into their descent. This is happening in every region of the U.S.

 

What’s next? One Omicron subvariant, called BA.4.6, is taking hold in the U.S. It doesn’t have a mutation on the spike protein, but another mutation is giving it a slight advantage, causing a very slow take over. We don’t think this will cause a wave, but BA.4.6 may become dominant.

We continue to see SARS-CoV-2 mutate at a remarkable rate. Just like we watch weather patterns for hurricanes, we have mutation surveillance for SARS-CoV-2. Another Omicron subvariant, BA.2.75, is on the horizon. We are seeing in India and Australia that it can outcompete BA.5 and BA.4.6, but we don’t think it will cause a Category Four hurricane. It will likely take over in the U.S., but relatively slowly, causing a small blip on our radar. Another possibility is that, for the first time, we see two subvariants co-circulating at the same time. Unfortunately, global surveillance has decreased, and the number of sequences shared per week has fallen by 90% since last winter. This means we are largely flying blind as to what new variants are popping up and what we may see in coming months.

 

What happens next is also dependent on behavior, as this changes going into fall/winter (schools open, people head inside with cool weather, groups gather for holidays). This combined with humidity and waning immunity is largely why we see seasonal patterns of other coronaviruses and the flu. We think one day we will see seasonality with SARS-CoV-2, but it is not yet predictable.

The next month or two will likely be quiet on the COVID-19 end. This is especially true is a substantial amount of people get the Omicron booster (more on this in a future post). We will have to wait and see how COVID-19 takes us into winter months. This is quite difficult to predict; I’m holding my breath.

Edited August 22, 2022 by mommyoffive

[mommyoffive]

Fauci plans to step down in December after half a century in government (msn.com)

[KSera]

I’m still wondering what the implications are of them having scrapped the BA 1/2 vaccine in favor of the BA 4/5 one in light of the below. At least it’s bivalent, so hopefully between the original and the new, it will still do decently against variants that arise from earlier lineages.

36 minutes ago, mommyoffive said:

BA.2.75, is on the horizon. We are seeing in India and Australia that it can outcompete BA.5 and BA.4.6

[Arcadia]

Pfizer and BioNTech Submit Application to U.S. FDA for Emergency Use Authorization of Omicron BA.4/BA.5-Adapted Bivalent COVID-19 Vaccine

https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-submit-application-us-fda-emergency-use
“

• Data support request for Emergency Use Authorization of a 30-µg booster dose of an Omicron BA.4/BA.5-adapted bivalent COVID-19 vaccine for individuals 12 years of age and older
• Companies have rapidly scaled production and stand ready to deliver doses of Omicron BA.4/BA.5-adapted bivalent vaccines for September, and will begin shipping immediately pending authorization
• Rolling submission for Omicron BA.4/BA.5-adapted bivalent vaccine to be completed with the European Medicines Agency in the coming days

(BUSINESS WIRE)-- Pfizer Inc. (NYSE: PFE) and BioNTech SE (Nasdaq: BNTX) today announced they have completed a submission to the U.S. Food and Drug Administration (FDA) requesting Emergency Use Authorization (EUA) of a booster dose of an Omicron BA.4/BA.5-adapted bivalent COVID-19 vaccine for individuals 12 years of age and older. The application follows guidance from the FDA to include clinical data from the companies’ bivalent Omicron BA.1-adapted vaccine and pre-clinical and manufacturing data from the companies’ bivalent Omicron BA.4/BA.5-adapted vaccine to address the continued evolution of SARS-CoV-2. Pending authorization, the Omicron BA.4/BA.5-adapted bivalent vaccine will be available to ship immediately.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20220822005376/en/

A conditional marketing authorization application has also been initiated with the European Medicines Agency (EMA) for the Omicron BA.4/BA.5-adapted bivalent vaccine and is expected to be completed in the coming days.“

[Mom_to3]

Are people going to get the Pfizer at the first opportunity or wait for the Moderna one? I am concerned that the one-time tiny half dose Omicron component is not enough to generate any kind of lasting response...On the other hand, fall semester is starting and we are about to have a lot of exposure.

[Matryoshka]

3 minutes ago, Mom_to3 said:

Are people going to get the Pfizer at the first opportunity or wait for the Moderna one? I am concerned that the one-time tiny half dose Omicron component is not enough to generate any kind of lasting response...On the other hand, fall semester is starting and we are about to have a lot of exposure.

I personally would like to wait for Moderna.  But I'm still unclear when that's coming out?

[Ali in OR]

I'm thinking I might wait for Moderna. All 4 of mine have been Pfizer and maybe it would be stronger to have the other type. I had Covid at the end of June/beginning of July. I thought it was probably BA2, but I was just looking at Oregon's surveillance data and it now shows more than 50% of cases that were typed from that time were BA5. So maybe I have a little more immunity for awhile.

[KSera]

8 minutes ago, Mom_to3 said:

Are people going to get the Pfizer at the first opportunity or wait for the Moderna one? I am concerned that the one-time tiny half dose Omicron component is not enough to generate any kind of lasting response...On the other hand, fall semester is starting and we are about to have a lot of exposure.

I’d love to see the data first. I’ll be looking today to see what Pfizer has released. My understanding though is that their clinical data isn’t ready yet? Typically, my preference would be Moderna, but since all of mine have been Moderna and it’s likely to take longer, in this case I may go Pfizer. Unless we have data showing that theirs isn’t working as well as Moderna’s. If I had had all Pfizer to this point, I might choose in the other direction, unless it looks like it will take significantly longer or if cases accelerate again before Moderna comes out. 

[Arcadia]

@wathe@Dicentra

MODERNA TO SUPPLY 12 MILLION DOSES OF OMICRON-CONTAINING BIVALENT COVID-19 BOOSTER VACCINES TO THE GOVERNMENT OF CANADA

https://investors.modernatx.com/news/news-details/2022/Moderna-to-Supply-12-Million-Doses-of-Omicron-Containing-Bivalent-COVID-19-Booster-Vaccines-to-the-Government-of-Canada/default.aspx

“CAMBRIDGE, MA / ACCESSWIRE / August 22, 2022 /Moderna, Inc. (NASDAQ:MRNA), a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines, today announced that the Government of Canada has exercised its option to purchase an additional 4.5 million doses of an Omicron-containing bivalent vaccine booster candidate from the Company, in addition to moving forward the scheduled delivery of 1.5 million doses of the bivalent vaccine candidate from 2023 to 2022.

Moderna and the Government of Canada have also agreed to convert six million doses of the Company's COVID-19 vaccine (Spikevax, mRNA-1273) to an Omicron-containing bivalent vaccine. The agreement is subject to regulatory approval of the Omicron-containing bivalent vaccine booster candidate by Health Canada, with doses scheduled for delivery in 2022.”

[wathe]

18 minutes ago, Arcadia said:

@wathe@Dicentra

MODERNA TO SUPPLY 12 MILLION DOSES OF OMICRON-CONTAINING BIVALENT COVID-19 BOOSTER VACCINES TO THE GOVERNMENT OF CANADA

https://investors.modernatx.com/news/news-details/2022/Moderna-to-Supply-12-Million-Doses-of-Omicron-Containing-Bivalent-COVID-19-Booster-Vaccines-to-the-Government-of-Canada/default.aspx

“CAMBRIDGE, MA / ACCESSWIRE / August 22, 2022 /Moderna, Inc. (NASDAQ:MRNA), a biotechnology company pioneering messenger RNA (mRNA) therapeutics and vaccines, today announced that the Government of Canada has exercised its option to purchase an additional 4.5 million doses of an Omicron-containing bivalent vaccine booster candidate from the Company, in addition to moving forward the scheduled delivery of 1.5 million doses of the bivalent vaccine candidate from 2023 to 2022.

Moderna and the Government of Canada have also agreed to convert six million doses of the Company's COVID-19 vaccine (Spikevax, mRNA-1273) to an Omicron-containing bivalent vaccine. The agreement is subject to regulatory approval of the Omicron-containing bivalent vaccine booster candidate by Health Canada, with doses scheduled for delivery in 2022.”

Yes, thank you, this has been all over the news.

Not much detail yet on what the final recipe will be, or what distribution will look like.  

I think it likely that frail elderly, immune-compromised, LTC and retirement home residents will be prioritized (and rightly so) and that HCW will not be prioritized (based on fact that we were not prioritized for 4th dose).

[mommyoffive]

Yay for doctors still having masks and other rules.  

[mommyoffive]

New COVID shot aimed at omicron strains could be ready in time for fall : Shots - Health News : NPR

 

Pfizer seeks authorization for new Covid booster, without fresh clinical data (statnews.com)

[mommyoffive]

FDA: Novavax Covid-19 Vaccine Is Now Authorized For Ages 12 To 17 (forbes.com)

[kbutton]

2 hours ago, mommyoffive said:

Yay for doctors still having masks and other rules.  

I think this varies by where you live. Not all doctors are masking around here, but most are. Hospitals here are still requiring docs and patients to mask.

[mommyoffive]

1 minute ago, kbutton said:

I think this varies by where you live. Not all doctors are masking around here, but most are. Hospitals here are still requiring docs and patients to mask.

Yep.  I am just doing a happy dance that our ped and eye doctor are still masking and enforcing.  The eye doctor is the most strict.  

[Mom_to3]

https://www.nbcnews.com/health/health-news/moderna-asks-fda-authorize-updated-covid-booster-shot-rcna44451

[mommyoffive]

13 minutes ago, Mom_to3 said:

https://www.nbcnews.com/health/health-news/moderna-asks-fda-authorize-updated-covid-booster-shot-rcna44451

yay

[wathe]

This paper came to my attention yesterday.  It's very good.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/ina.13070

What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic?

Jose L. Jimenez, Linsey C. Marr, Katherine Randall, Edward Thomas Ewing, Zeynep Tufekci, Trish Greenhalgh, Raymond Tellier, Julian W. Tang, Yuguo Li, Lidia Morawska, Jonathan Mesiano-Crookston, David Fisman, Orla Hegarty, Stephanie J. Dancer, Philomena M. Bluyssen, Giorgio Buonanno, Marcel G. L. C. Loomans, William P. Bahnfleth, Maosheng Yao, Chandra Sekhar, Pawel Wargocki, Arsen K. Melikov, Kimberly A. Prather … See fewer authors 

First published: 21 August 2022

 

[Arcadia]

WaPo, very long article  https://www.washingtonpost.com/health/2022/08/22/coronavirus-immune-response-boosters/

”Your first brush with coronavirus could affect how a fall booster works

…

The answers to those questions will influence our long-term relationship with the coronavirus — and the health of millions of people. But more than two years into the pandemic, the quest to unravel these riddles underscores the seemingly unending complexity of the battle against a new pathogen.

When the virus emerged, no one had encountered SARS-CoV-2 before, so our immune systems started in pretty much the same vulnerable spot — what scientists call “naive.”

Now, people have been infected, vaccinated, boosted, reinfected and boosted again — in varying combinations. People’s immune systems are on slightly different learning curves, depending on when they were infected or vaccinated, and with what variants or vaccines.

“There are no cookie-cutter answers here,” said John P. Moore, a professor of microbiology and immunology at Weill Cornell Medicine. “An omicron infection after vaccination doesn’t mean you’re not going to get another one a bit further down the road. How long is a bit further down the road?”

Scientists are watching in real time as original antigenic sin plays out against the coronavirus — and debating how it will influence future vaccine strategy. Contrary to its biblical thunderclap of a name, the phenomenon is nuanced — more often beneficial or neutral than harmful.

It helps explain why vaccines based on the original virus continue to keep people out of the hospital, despite challenging new variants. But it may also mean that revamped fall boosters have limited benefits, because people’s immune memories are dominated by their first experience with the virus.

“We may have gotten about as much advantage out of the vaccine, at this point, as we can get,” said Barney Graham, an architect of coronavirus vaccines who now focuses on global health equity at Morehouse School of Medicine in Atlanta. Graham emphasizes that the vaccines are doing exactly what they were designed to do: keep people out of the hospital. Retuning them will have benefits, albeit limited.

“We can tweak it and maybe evolve it to match circulating strains a little better,” Graham said. “It will have a very small, incremental effect.”

Echoes of immunity

More than 60 years ago, a virologist named Thomas Francis Jr., observed that influenza infections in childhood had lifelong repercussions. For decades after, people’s immune systems carry an imprint from their first flu, activating defenses primarily against the original version of the virus they encountered. He called it “the doctrine of original antigenic sin.”

The same thing is happening with the coronavirus. A growing number of studies show that when the omicron variant infects, it causes the immune system to rapidly activate immune memory cells that are already on standby, created by previous vaccinations or infections.

“People are now walking around with different immune-imprinted covid responses, depending on what vaccine schedules they’ve had — one, two or three doses — and what infections they have had in the past,” said Rosemary Boyton, a professor of immunology and respiratory medicine at Imperial College London. “Imprinting is different according to where you live in the world, what vaccines you received — and that’s determining the subsequent immune response.”

In flu, the immunological echoes of original antigenic sin have real consequences: When flu strains are similar to the ones encountered in childhood, people are better protected against severe illness. The 1918 flu pandemic was caused by an H1N1 strain, which continued to circulate for decades afterward. When the 2009 H1N1 pandemic occurred, older people who were exposed to H1N1 in childhood had stronger immune responses than younger people who had been infected with other strains. When a flu strain is a more distant relative of that initial exposure, people may be more susceptible.

…

‘A dog’s dinner’

The most gloomy interpretation of original antigenic sin holds that the immune system is stuck fighting an old war. Each new infection leaves behind no useful immune memory, instead summoning defenses against antiquated versions of the virus.

“Your coronavirus immunity repertoire is such a dog’s dinner it might actually enhance immunity to past variants a little bit, in ways that aren’t useful anymore,” said Danny Altmann, an immunologist at Imperial College London.

He and Boyton published a Science paper in June that suggested people who were infected with the original version of the coronavirus and later vaccinated and reinfected with omicron mustered subpar immune responses to omicron. Their interpretation: People’s immune systems were locked into a fight against older iterations of the virus.

Not so fast, say others, who think there may be explanations other than original antigenic sin.

An essential element of how the immune system works is memory, the ability to recall viruses that have infected people before. Although virus-fighting antibodies naturally drop over time, memory B cells kick into action and churn them out on demand when a virus intrudes.

When viruses evolve, as is happening with the coronavirus variants, this memory can still be quite useful. Viruses typically swap out only bits of their costume. Parts of the spike protein of omicron look very different, but other bits look the same.

“What our immune system likes to do best is recognize things it already has seen. It responds very quickly to these parts of the virus that haven’t changed,” said Matthew S. Miller, a viral immunologist at McMaster University. “The vaccines are still doing an exceptionally good job in preventing us from getting severe illness. The reason is that is, essentially, original antigenic sin.”

This hair-trigger immune response isn’t fine-tuned to block the new virus; people can still get infected. But a suboptimal response that’s ready to go, many scientists think, is better than waiting for the body to create one from scratch.

“Essentially, original antigenic sin is often a very good thing,” said Laura Walker, chief scientific officer of Adagio Therapeutics, a biotechnology company focused on developing monoclonal antibody drugs. Walker recently published a paper showing that vaccinated people who came down with an omicron infection had an initial immune response driven by the immune cells created by their original vaccination.

This burst of antibodies capable of recognizing a new variant is not surprising to experts. It’s Immunology 101. And in the case of the coronavirus, it helps.

…

New memories

What scientists don’t know yet is what happens in the weeks and months after an infection or new vaccine.

One possibility: The immune system creates a new memory of the new variant. The next time a descendant of omicron comes along, the body can draw from an expanded memory bank to mount its next defense.

Another, more worrisome scenario: The fast-draw immune response interferes with the creation of new memories. The next time a version of the virus comes along, the body simply reactivates the existing response — and eventually, a variant comes along that is so changed it is unrecognizable.

“The question is: Is that memory pool going to get broadened, or is it going to get fixated?” said Wayne A. Marasco, an immunologist at Dana-Farber Cancer Institute.

The Food and Drug Administration asked companies in June to update coronavirus boosters for the fall, to a shot that includes two components: one that targets the original strain; and the other tailored to fight the most recent variants, BA.4 and BA.5.

Companies showed preliminary data that vaccines containing those versions of the virus can trigger stronger immune responses in the weeks after vaccination. But the advantage of a switch was modest, and long-term effects of those vaccines will depend in part on whether they help create new memories. If they simply provide a short-term boost of the existing memory response, many scientists are debating a change in vaccine strategy.

“This is not in my mind going to be the dramatic change to limit symptomatic omicron infection,” said Robert Seder, chief of the Cellular Immunology Section at the National Institute of Allergy and Infectious Diseases. Seder showed in a primate study this year that an omicron booster did no better than an additional shot of the original vaccine. He has focused his efforts on a change in tactics, such as a nasal vaccine that could help block infections and spread of the virus.

Even though a revamped vaccine is unlikely to be a game changer, many scientists favor an update. Rafi Ahmed, an immunologist at Emory University, argues that an omicron-based booster is urgently needed.

“There is no point continuing to vaccinate someone with a strain that is not circulating,” Ahmed said. Even if a new omicron-specific memory does not coalesce, the variant-specific vaccine will recruit and rev the part of the memory response capable of recognizing omicron.“

[mommyoffive]

4 minutes ago, Arcadia said:

WaPo, very long article  https://www.washingtonpost.com/health/2022/08/22/coronavirus-immune-response-boosters/

”Your first brush with coronavirus could affect how a fall booster works

…

The answers to those questions will influence our long-term relationship with the coronavirus — and the health of millions of people. But more than two years into the pandemic, the quest to unravel these riddles underscores the seemingly unending complexity of the battle against a new pathogen.

When the virus emerged, no one had encountered SARS-CoV-2 before, so our immune systems started in pretty much the same vulnerable spot — what scientists call “naive.”

Now, people have been infected, vaccinated, boosted, reinfected and boosted again — in varying combinations. People’s immune systems are on slightly different learning curves, depending on when they were infected or vaccinated, and with what variants or vaccines.

“There are no cookie-cutter answers here,” said John P. Moore, a professor of microbiology and immunology at Weill Cornell Medicine. “An omicron infection after vaccination doesn’t mean you’re not going to get another one a bit further down the road. How long is a bit further down the road?”

Scientists are watching in real time as original antigenic sin plays out against the coronavirus — and debating how it will influence future vaccine strategy. Contrary to its biblical thunderclap of a name, the phenomenon is nuanced — more often beneficial or neutral than harmful.

It helps explain why vaccines based on the original virus continue to keep people out of the hospital, despite challenging new variants. But it may also mean that revamped fall boosters have limited benefits, because people’s immune memories are dominated by their first experience with the virus.

“We may have gotten about as much advantage out of the vaccine, at this point, as we can get,” said Barney Graham, an architect of coronavirus vaccines who now focuses on global health equity at Morehouse School of Medicine in Atlanta. Graham emphasizes that the vaccines are doing exactly what they were designed to do: keep people out of the hospital. Retuning them will have benefits, albeit limited.

“We can tweak it and maybe evolve it to match circulating strains a little better,” Graham said. “It will have a very small, incremental effect.”

Echoes of immunity

More than 60 years ago, a virologist named Thomas Francis Jr., observed that influenza infections in childhood had lifelong repercussions. For decades after, people’s immune systems carry an imprint from their first flu, activating defenses primarily against the original version of the virus they encountered. He called it “the doctrine of original antigenic sin.”

The same thing is happening with the coronavirus. A growing number of studies show that when the omicron variant infects, it causes the immune system to rapidly activate immune memory cells that are already on standby, created by previous vaccinations or infections.

“People are now walking around with different immune-imprinted covid responses, depending on what vaccine schedules they’ve had — one, two or three doses — and what infections they have had in the past,” said Rosemary Boyton, a professor of immunology and respiratory medicine at Imperial College London. “Imprinting is different according to where you live in the world, what vaccines you received — and that’s determining the subsequent immune response.”

In flu, the immunological echoes of original antigenic sin have real consequences: When flu strains are similar to the ones encountered in childhood, people are better protected against severe illness. The 1918 flu pandemic was caused by an H1N1 strain, which continued to circulate for decades afterward. When the 2009 H1N1 pandemic occurred, older people who were exposed to H1N1 in childhood had stronger immune responses than younger people who had been infected with other strains. When a flu strain is a more distant relative of that initial exposure, people may be more susceptible.

…

‘A dog’s dinner’

The most gloomy interpretation of original antigenic sin holds that the immune system is stuck fighting an old war. Each new infection leaves behind no useful immune memory, instead summoning defenses against antiquated versions of the virus.

“Your coronavirus immunity repertoire is such a dog’s dinner it might actually enhance immunity to past variants a little bit, in ways that aren’t useful anymore,” said Danny Altmann, an immunologist at Imperial College London.

He and Boyton published a Science paper in June that suggested people who were infected with the original version of the coronavirus and later vaccinated and reinfected with omicron mustered subpar immune responses to omicron. Their interpretation: People’s immune systems were locked into a fight against older iterations of the virus.

Not so fast, say others, who think there may be explanations other than original antigenic sin.

An essential element of how the immune system works is memory, the ability to recall viruses that have infected people before. Although virus-fighting antibodies naturally drop over time, memory B cells kick into action and churn them out on demand when a virus intrudes.

When viruses evolve, as is happening with the coronavirus variants, this memory can still be quite useful. Viruses typically swap out only bits of their costume. Parts of the spike protein of omicron look very different, but other bits look the same.

“What our immune system likes to do best is recognize things it already has seen. It responds very quickly to these parts of the virus that haven’t changed,” said Matthew S. Miller, a viral immunologist at McMaster University. “The vaccines are still doing an exceptionally good job in preventing us from getting severe illness. The reason is that is, essentially, original antigenic sin.”

This hair-trigger immune response isn’t fine-tuned to block the new virus; people can still get infected. But a suboptimal response that’s ready to go, many scientists think, is better than waiting for the body to create one from scratch.

“Essentially, original antigenic sin is often a very good thing,” said Laura Walker, chief scientific officer of Adagio Therapeutics, a biotechnology company focused on developing monoclonal antibody drugs. Walker recently published a paper showing that vaccinated people who came down with an omicron infection had an initial immune response driven by the immune cells created by their original vaccination.

This burst of antibodies capable of recognizing a new variant is not surprising to experts. It’s Immunology 101. And in the case of the coronavirus, it helps.

…

New memories

What scientists don’t know yet is what happens in the weeks and months after an infection or new vaccine.

One possibility: The immune system creates a new memory of the new variant. The next time a descendant of omicron comes along, the body can draw from an expanded memory bank to mount its next defense.

Another, more worrisome scenario: The fast-draw immune response interferes with the creation of new memories. The next time a version of the virus comes along, the body simply reactivates the existing response — and eventually, a variant comes along that is so changed it is unrecognizable.

“The question is: Is that memory pool going to get broadened, or is it going to get fixated?” said Wayne A. Marasco, an immunologist at Dana-Farber Cancer Institute.

The Food and Drug Administration asked companies in June to update coronavirus boosters for the fall, to a shot that includes two components: one that targets the original strain; and the other tailored to fight the most recent variants, BA.4 and BA.5.

Companies showed preliminary data that vaccines containing those versions of the virus can trigger stronger immune responses in the weeks after vaccination. But the advantage of a switch was modest, and long-term effects of those vaccines will depend in part on whether they help create new memories. If they simply provide a short-term boost of the existing memory response, many scientists are debating a change in vaccine strategy.

“This is not in my mind going to be the dramatic change to limit symptomatic omicron infection,” said Robert Seder, chief of the Cellular Immunology Section at the National Institute of Allergy and Infectious Diseases. Seder showed in a primate study this year that an omicron booster did no better than an additional shot of the original vaccine. He has focused his efforts on a change in tactics, such as a nasal vaccine that could help block infections and spread of the virus.

Even though a revamped vaccine is unlikely to be a game changer, many scientists favor an update. Rafi Ahmed, an immunologist at Emory University, argues that an omicron-based booster is urgently needed.

“There is no point continuing to vaccinate someone with a strain that is not circulating,” Ahmed said. Even if a new omicron-specific memory does not coalesce, the variant-specific vaccine will recruit and rev the part of the memory response capable of recognizing omicron.“

Thanks for posting this.  I saw the article earlier but didn't have access to read it.

[mommyoffive]

[mommyoffive]

Fall boosters: An update - by Katelyn Jetelina (substack.com)

 

 

What are the new boosters?

 

The fall booster will be a bivalent vaccine, which means its formula covers two variants: the original Wuhan virus and Omicron (BA.5). As of yesterday, Pfizer and Moderna submitted their emergency use applications to the FDA.

• Pfizer: This will be a 30 microgram vaccine, which is the same dosage as the original series. Pfizer is first seeking approval for those aged 12 and older. But they did confirm they are working on a booster for ages 6 months to 11 years. CDC confirmed this in their fall planning guide, saying that we should expect a booster for younger kiddos following the adults.

• Moderna: This booster will be a 50 microgram vaccine, which is the same dosage as the original booster and half the dosage of the original Moderna series. They are seeking approval for ages 18 years and older.

 

 

 

 

An important note

 

This will be the last vaccine that is freely to the American public. We could barely find enough money to purchase fall boosters for everyone. Congress has stopped funding the coronavirus response and has invested very little into pandemic preparedness. This will be a tragedy on many fronts.

 

[mommyoffive]

U.S. life expectancy saw biggest drop since Second World War in 2020. These states saw the biggest decline | Fortune

[Malory]

Paxlovid not clearly benefitting younger adults (under 65).

https://www.nejm.org/doi/full/10.1056/NEJMoa2204919

CONCLUSIONS

Among patients 65 years of age or older, the rates of hospitalization and death due to Covid-19 were significantly lower among those who received nirmatrelvir than among those who did not. No evidence of benefit was found in younger adults.

[mommyoffive]

FDA Plans To Authorize Boosters Aimed at Omicron BA.4, BA.5 Around Labor Day – NBC Chicago

[Laura Corin]

Unintended Omicron consequences.  My colleague is down with Covid. Students start to arrive in a week.  She's new in the job and behind with work. I don't know what she has completed already. And this is the busiest time in my work calendar. I  want to lie down in the dark and not come out for three weeks.

She was feeling very rough on Thursday.  As far as I know she's triple-jabbed. So she may come out of it fairly soon.

Edited August 28, 2022 by Laura Corin

[mommyoffive]

COVID test kits: Government to suspend free USPS tests on or before Sept. 2 (axios.com)

[mommyoffive]

Omicron COVID-19 booster shots are coming: Will they be a game-changer? - Los Angeles Times (latimes.com)

[TCB]

I was wondering if anyone has any insight into whether including the original Wuhan strain in the new booster, along with BA.5, is a good thing or a bad thing. I’ve been waiting for that for a booster, but was reading, although not really understanding, some stuff about OAS. Could someone explain it? 
The other option might be Novavax as a booster, if that is an option. Any insights would be very appreciated.

[TCB]

Also, it’s my dd’s second week of classes at university and already 2 of her professors are off with Covid. No mitigations being attempted at this college at all.

[mommyoffive]

Why Some Americans Are Still Isolating From Covid-19 (msn.com)

[KSera]

29 minutes ago, mommyoffive said:

Why Some Americans Are Still Isolating From Covid-19 (msn.com)

It came across as snarky and uninformed when it said that people at low risk of serious disease who are still concerned about Covid should discuss their risk with a mental health professional. Therapists and other mental health professionals  are not likely to be well-versed in what someone’s risk of long Covid or other post Covid sequelae are. Why would I talk to a therapist about it? I pay attention to what scientists and doctors actually working with the disease are saying. A large number are appalled that so many are pretending we aren’t still in a pandemic with a very elevated number of excess deaths still. I see many, if not most of them encouraging people to continue to take precautions such as wearing a mask indoors, ventilating and cleaning the air. 

[KSera]

Ugh, this poor doctor. She treats Covid patients and is now down with her third omicron infection since March 😢. She’s questioning if she can keep going back. 

 

[Laura Corin]

3 hours ago, KSera said:

It came across as snarky and uninformed when it said that people at low risk of serious disease who are still concerned about Covid should discuss their risk with a mental health professional. Therapists and other mental health professionals  are not likely to be well-versed in what someone’s risk of long Covid or other post Covid sequelae are. Why would I talk to a therapist about it? I pay attention to what scientists and doctors actually working with the disease are saying. A large number are appalled that so many are pretending we aren’t still in a pandemic with a very elevated number of excess deaths still. I see many, if not most of them encouraging people to continue to take precautions such as wearing a mask indoors, ventilating and cleaning the air. 

Yes.  Long Covid is serious - ask my brother. 

And the effect of getting Covid on those around you, for example colleagues - ask me - is also serious.  If I wasn't masking, there might be no one to supervise all the arrangements needed for a thousand incoming students.

Edited August 30, 2022 by Laura Corin

[bookbard]

I'm wondering whether another consequence of covid will be increased class sizes in schools because a) they just can't get the teachers for more classes, and b) admin will argue half the kids are off sick each day anyway, so it's technically not a class size increase?

[Ausmumof3]

6 hours ago, TCB said:

I was wondering if anyone has any insight into whether including the original Wuhan strain in the new booster, along with BA.5, is a good thing or a bad thing. I’ve been waiting for that for a booster, but was reading, although not really understanding, some stuff about OAS. Could someone explain it? 
The other option might be Novavax as a booster, if that is an option. Any insights would be very appreciated.

I saw a good discussion on this the other day. I’m going to see if I can find it(it may even be the same thing you’ve seen).

ETA

i think it was the WAPO article in this Twitter thread or some discussion around it? I don’t think it’s super clear yet whether it’s an issue or not.

Edited August 30, 2022 by Ausmumof3

[Ausmumof3]

My understanding is that with some viruses the body does a great job of remembering the original version but doesn’t bother to make updates antibodies when it sees new versions. So it keeps responding to the original strain. Having the original strain vaccine with the new variant vaccines may make this even more likely as the body sees the original strain and thinks that’s all it needs to fight. So it could make the omicron booster less effective against omicron. But if we get a new variant that stems off an older strain (say through someone immunocompromised who has had a long running infection from way back) having the original antibodies might be more helpful. 
 

[Ausmumof3]

https://www.science.org/doi/10.1126/science.abq1841
 

Also this Science paper is kind of related.

Vaccine boosting results in distinct, imprinted patterns of hybrid immunity with different combinations of SARS-CoV-2 infection and vaccination. Immune protection is boosted by B.1.1.529 (Omicron) infection in the triple-vaccinated, previously infection-naïve individuals, but this boosting is lost with prior Wuhan Hu-1 imprinting. This “hybrid immune damping” indicates substantial subversion of immune recognition and differential modulation through immune imprinting and may be the reason why the B.1.1.529 (Omicron) wave has been characterized by breakthrough infection and frequent reinfection with relatively preserved protection against severe disease in triple-vaccinated individuals.

[mommyoffive]

9 hours ago, KSera said:

It came across as snarky and uninformed when it said that people at low risk of serious disease who are still concerned about Covid should discuss their risk with a mental health professional. Therapists and other mental health professionals  are not likely to be well-versed in what someone’s risk of long Covid or other post Covid sequelae are. Why would I talk to a therapist about it? I pay attention to what scientists and doctors actually working with the disease are saying. A large number are appalled that so many are pretending we aren’t still in a pandemic with a very elevated number of excess deaths still. I see many, if not most of them encouraging people to continue to take precautions such as wearing a mask indoors, ventilating and cleaning the air. 

Yes.  I feel like that is the only area where there is still a call to do things.  We are still trying not to get sick, but we are surrounded by people who never did anything anyhow.  Plus having to go back work for my dh where there is no mask rules currently so hardly anyone is wearing a mask but him.  We are trying, but I know that our efforts can't stop everything.  But yeah everywhere has removed all rules and it makes me feel bad, dumb, odd for still masking everywhere even though i know all the science behind it.   I am so thankful for places that still have some precautions in place.  It feels like finding a 4 leaf clover.  We are going to the eye doc today and they have tons of rules.  

[mommyoffive]

6 hours ago, bookbard said:

I'm wondering whether another consequence of covid will be increased class sizes in schools because a) they just can't get the teachers for more classes, and b) admin will argue half the kids are off sick each day anyway, so it's technically not a class size increase?

I don't know how they can't increase.  I keep reading articles that all these districts have hundreds open teaching jobs  as the year is starting.  And then I am hearing how many teachers our out in sick within the first week or two.  

[kbutton]

8 hours ago, KSera said:

Ugh, this poor doctor. She treats Covid patients and is now down with her third omicron infection since March 😢. She’s questioning if she can keep going back. 

 

That's really surprising. She says she wears FFP2/3 masks, which look good when I googled them. I wonder if it's from contact in her personal life (which is how DH's coworkers are getting it). She did say not all patients are masked, but with a good mask, I would be surprised if it matters that much. 

6 hours ago, Laura Corin said:

And the effect of getting Covid on those around you, for example colleagues - ask me - is also serious.  If I wasn't masking, there might be no one to supervise all the arrangements needed for a thousand incoming students.

I don't know why this isn't acknowledged a lot more often. I feel like people who are showing up, not infecting others, and not getting sick should get bonuses every time their coworkers or fellow students are getting sick.